Provider Demographics
NPI:1841999430
Name:MOLECULAR LAB ASSOCIATES ILLINOIS
Entity type:Organization
Organization Name:MOLECULAR LAB ASSOCIATES ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-645-8862
Mailing Address - Street 1:16124 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8417
Mailing Address - Country:US
Mailing Address - Phone:913-379-9230
Mailing Address - Fax:
Practice Address - Street 1:2908 GREENBRIAR DR STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7433
Practice Address - Country:US
Practice Address - Phone:833-480-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory